ABSTRACT
A 66 years old male presented with severe right-sided otalgia and throat pain, which persisted more than a year. He also complained of bilateral tinnitus. Tinnitus was continuous and high-pitched. Severe pain usually followed swallowing food. Pressing his right tonsil aggravated such symptoms. Pure tone audiogram showed both high frequencies hearing loss. Neck CT image revealed a small tonsillolith in his right tonsil. Gabapentin and non-steroidal anti-inflammatory drugs reduced the intensity of pain, but could not eradicate the pain. Finally, we performed radiofrequency tonsil ablation to eliminate right side tonsillolith. After ablation, pain immediately subsided and his tinnitus also disappeared. Tiny impacted tonsillolith may induce glossopharyngeal neuralgia and somatic tinnitus.
ABSTRACT
IgG4-related systemic disease, including autoimmune pancreatitis, is a multi-organ disorder characterized by elevated serum immunoglobulin G4 (IgG4) concentration and IgG4-positive plasma cell infiltration. We report a case of a 66-year-old woman with IgG4-related hearing disorder, presenting with fluctuating mixed hearing loss with middle ear effusion. The serum IgG4 level was elevated and pathological examination revealed dense infiltration of IgG4-positive lymphocyte in the renal parenchyma, lung tissue and lacrimal gland. With intravenous methylprednisolone at a dose of 60 mg daily, improvement of hearing loss were observed. No recurrence was observed for 6 months with mainternance of prednisolone and methotrexate.
Subject(s)
Aged , Female , Humans , Autoimmune Diseases , Hearing Disorders , Hearing Loss , Hearing Loss, Mixed Conductive-Sensorineural , Immunoglobulin G , Immunoglobulins , Lacrimal Apparatus , Lung , Lymphocytes , Methotrexate , Methylprednisolone , Otitis Media with Effusion , Pancreatitis , Plasma Cells , Prednisolone , RecurrenceABSTRACT
IgG4-related systemic disease, including autoimmune pancreatitis, is a multi-organ disorder characterized by elevated serum immunoglobulin G4 (IgG4) concentration and IgG4-positive plasma cell infiltration. We report a case of a 66-year-old woman with IgG4-related hearing disorder, presenting with fluctuating mixed hearing loss with middle ear effusion. The serum IgG4 level was elevated and pathological examination revealed dense infiltration of IgG4-positive lymphocyte in the renal parenchyma, lung tissue and lacrimal gland. With intravenous methylprednisolone at a dose of 60 mg daily, improvement of hearing loss were observed. No recurrence was observed for 6 months with mainternance of prednisolone and methotrexate.
Subject(s)
Aged , Female , Humans , Autoimmune Diseases , Hearing Disorders , Hearing Loss , Hearing Loss, Mixed Conductive-Sensorineural , Immunoglobulin G , Immunoglobulins , Lacrimal Apparatus , Lung , Lymphocytes , Methotrexate , Methylprednisolone , Otitis Media with Effusion , Pancreatitis , Plasma Cells , Prednisolone , RecurrenceABSTRACT
BACKGROUND: Adolesoents experience many physical, psychological and social stresses. It is well known that there is a strong relationship between stress and illness. It has been told that good health goes with good health habits. We examine the relationship between several health habits and stress in adolescents. METHODS: We surveyed adolescents and their parents who visited an adolescent clinic in a general hospital for 8 manths. Structured questionnaires about status of several health habits and BEPSI(The Brief Encounterr Psychosocial Instrument) score were used. BEPSI is a quick stress measure that is composed of several items. RESULTS: This study included 486 adolescents and their 486 parents. Average number of good health habits was 3.2+/-1.7 and average BEPSI score was 2.1+/-0.6. The group that had more good health habits tended to mark lower BEPSI scores(p<0.05). There was a significant relationship between stress and each habit except sleep time of more than 7hrs, regular exercise and hobby. Smoker group and alcohol drinker group showed higher BEPSI scores, respectively. The conversation time between parents and adolescents had a significant relationship with BEPSI scores. CONCLUSIONS: Several health habits were significantly connected with stress in adolescents. We can assume that good health habits and conversation with their parents are important in the management of stress in adolescents.
Subject(s)
Adolescent , Humans , Hobbies , Hospitals, General , Parents , Surveys and QuestionnairesABSTRACT
BACKGROUNDS: Proper managements of diabetes is important in family practice. this study aimed to assess the quality of diabetes care in an outpatient department of family medicine in a general hospital. METHODS: We reviewed all the charts of patients who had a new diagnosis code of diabetes in an outpatient department if family medicine at Asan medical center from January 1, 1994 to December 31, 1995. The documentation of medical history, physical examination, laboratory tests and treatments were examined. We surveyed the doctors who had managed the above patients. RESULTS: This study include d95 patients with diabetes were documented in 61,1 % and 336%, respectively. Blood pressure measurement, fundus examination and neurologic examination were done in 100.0%., 47.4% and 18.9%, respectively. Lipid profile and urine microalbumin were checked in 477.4 % and 1.00%, respectively. Management if hypertension and exercise education were documented in 65.0% and 47.4%, respectively. In the doctor survey, doctors responded that they had provided services to diabetic patients more frequently than the results of chart audit except on a few items. CONCLUSIONS: The care of diabetic patients was relatively adequate in many items, but insufficient in some item. Efforts to improve the quality of diabetes care in family practice ar needed.